Rat soup, snails and oracles: why Nigeria’s traditional midwives still play a vital role

TThe sound of chants fills the narrow hallway that serves as a waiting room as about thirty pregnant women pray for safe deliveries and protection from sorcerers, witches and other enemies they believe could harm them or their babies.

The women take turns going to the small bathroom, where they stand on a rock and use soap, nest-like straw sponges, and seeds blessed by a prophet to wash away evil spirits.

Then they are ready to see Ronke Oje, the founder of the medicine clinic. She measures their heart rates, asks about headaches, sleeping and eating habits, checks the fetuses’ heart rates and provides personalized mixtures of herbs and seeds.

Later, when the women are ready to give birth, she will give them palm oil or fermented seaweed water to speed up the delivery process. If a woman is bleeding more than normal, she will insert a mixture of crushed snail shells and lime juice into the vagina to stop the bleeding.

In extreme cases, she will “bewitch the flow” by boiling a sample of the patient’s blood on a stove in the clinic’s kitchen until it dries out.

Oje is a traditional birth attendant (TBA), or midwife, locally known as lya abiye in Yoruba, meaning “Mother and child live”. She is one of thousands of such counselors in Lagos State and has been helping women in Mushin, one of Lagos’ poorest districts, get pregnant and give birth for 26 years.

In Nigeria, the doctor-patient ratio is among the highest lowest in the worldwhile maternal and infant mortality rates are among the highest. More than 60% of births in the country happen outside medical centers or hospitals, especially with the help of people like Oje.

A lack of health insurance, fear of surgery and high hospital bills can prevent patients from visiting modern doctors.

Women often trust TBAs, which draw on the traditional knowledge of the Yoruba people, and use herbs, plants, seeds, snail shells or dried animal parts to treat patients, as well as elements of evangelical Christianity. Many patients visit ‘charismatic churches’, where witchcraft and animistic spirituality play an important role.

The medical profession may not condone the treatments used by TBAs, but it recognizes the critical role they play in maternal and child care, and the importance of collaboration between conventional clinicians and TBAs.

In Lagos, the Traditional Medicine Board was established in the 1980s as part of the state Ministry of Health to register, regulate and connect traditional practices to the medical system. Today, more than 10,600 herbal and religious healers and birth attendants are licensed by Lagos State, although there are likely many more who are not registered.

“We all want mothers and babies to be safe and healthy, but for effective collaboration, trust must first be built,” says Dr. David Enushai, gynecologist and founder of the private Absolute Care maternity hospital.

Over the past three years, Enushai has worked with 60 TBAs, mainly from the Mushin area, giving monthly lectures on various aspects of maternity care. He teaches them how to recognize risks to the health of the mother or baby and when to refer the patient to the hospital. As a result, patients treated by traditional birth attendants come to Enushai early, often for the ultrasound in the first trimester.

When TBAs bring their patients to Enushai to find out the baby’s gender and due date, he takes the opportunity to recheck the fetal heart rate and see if there are any possible abnormalities.

He also provides the midwives with essential equipment, including sutures, syringes and gloves, as well as misoprostol and oxytocin in case of postpartum bleeding.

“When an emergency occurs, the idea is for them to provide first aid, prepare patients for transport before the ambulance arrives, set up an IV access and a hydration drip, so that blood loss is reduced and invaluable minutes are saved,” says Enushai, who also heads the Enushai Foundation, which provides affordable health care to pregnant women and mothers.

Dr. Kemi DaSilva-Ibru, gynecologist and founder of the Women at Risk International Foundation (Warif) also recognizes the broader role that traditional birth attendants play in women’s lives.

Since 2017, her Lagos-based foundation has trained more than 11,000 TBAs as first responders to cases of sexual and gender-based violence in Lagos, Ogun and Oyo states.

“As a doctor, it is sometimes difficult to remain silent (if you disagree with their methods),” says DaSilva-Ibru. “That’s why I often decide to leave my medical hat at home when working with TBAs, otherwise clashes arise.

“One thing cannot be denied, however: their role in our society,” she says. “They are neighbors, keepers of secrets and gatekeepers of women in these communities. We have to work with them.”

While TBAs work with doctors and attend trainings funded by Lagos State authorities, the belief in indigenous spirituality remains central to traditional medicine. Alayode Olaogun, the leader of a local healers’ association, runs the largest traditional medicine center in the area.

Every day, the clinic’s waiting room is full. Aishat Husseini, pregnant with her sixth child, is one of the women seeking treatment. Her previous deliveries were attended by her mother in northern Nigeria, where she used to live.

This time, after moving to Lagos, she wanted to have her baby in a hospital. But during her first visit, she learned that her baby was breech and that she would likely need a C-section. The possibility of surgical intervention scared her, and instead of returning to the hospital, she turned to Olaogun.

“I came for about two weeks, chanting prayers, getting herbs and drinking different soups,” Husseini says. “Once there was a dried rat in there, but I didn’t know until I saw its tail. I didn’t mind; the soup was delicious and I trusted that it would work. The baby turned over and I’m staying here in the clinic to give birth.”

She knows she can come at any time, day or night, since Olaogun lives in the clinic. “My father had this clinic, and his father was here before. I am the third in the family. Women know where we are,” he says.

Caring for his patients’ mental well-being is just as important as checking on their physical health. “During the clinic days, we sing and pray, try to make them happy and calm, and they confide in us,” says Olaogun. “We also tell them what to eat; we warn them not to eat chocolate, soda or sugar during pregnancy. Every time they come, we give them soup made with snails, fish, herbs and other things.

“If I see a problem, like if the baby is in a breech position, I consult an oracle that I work with and trust. I know she is talking to spirits and I do what she tells me the woman needs to get better.”